NEW VIEW VIDEO

NEW VIEW BOOK

The New View Manifesto

Introduction: Beyond the medical model of sexuality

In
recent years, publicity about new treatments for men's
erection problems has focused attention on women's sexuality
and provoked a competitive commercial hunt for "the female Viagra." But
women's sexual problems differ from men's in basic ways
which are not being examined or addressed. We believe that
a fundamental barrier to understanding women's sexuality
is the medical classification scheme in current use, developed by the
American Psychiatric Association (APA) for its Diagnostic and Statistical
Manual of Disorders (DSM) in 1980, and revised in 1987 and 1994. [ 2 ]
It divides (both men's and) women's sexual problems into four categories
of sexual "dysfunction":
sexual desire disorders, sexual arousal disorders, orgasmic
disorders, and sexual pain disorders.

These "dysfunctions" are disturbances in an assumed
universal physiological sexual response pattern ("normal function") originally
described by Masters and Johnson in the 1960s. [ 3 ]
This universal pattern begins, in theory, with sexual drive, and proceeds sequentially
through the stages of desire, arousal, and orgasm.

In recent decades, the shortcomings of the framework, as it applies
to women, have been amply documented. [ 4 ]
The three most serious distortions produced by a framework that reduces
sexual problems to disorders of physiological function, comparable to
breathing or digestive disorders, are:

1) A false notion of sexual equivalency between men and women. Because the
early researchers emphasized similarities in men's and women's physiological
responses during sexual activities, they concluded that sexual disorders
must also be similar. Few investigators asked women to describe their experiences
from their own points of view. When such studies were done, it became apparent
that women and men differ in many crucial ways. Women's accounts do not fit
neatly into the Masters and Johnson model; for example, women generally do
not separate "desire" from "arousal," women care less about physical than subjective
arousal, and women's sexual complaints frequently focus on "difficulties" that
are absent from the DSM. [ 5 ]

Furthermore, an emphasis on genital and physiological similarities between
men and women ignores the implications of inequalities related to gender,
social class, ethnicity, sexual orientation, etc. Social, political, and
economic conditions, including widespread sexual violence, limit women's
access to sexual health, pleasure, and satisfaction in many parts of the
world. Women's social environments thus can prevent the expression of biological
capacities, a reality entirely ignored by the strictly physiological framing
of sexual dysfunctions.

2) The erasure of the relational context of sexuality. The American Psychiatric
Association's DSM approach bypasses relational aspects of women's sexuality,
which often lie at the root of sexual satisfactions and problems--e.g., desires
for intimacy, wishes to please a partner, or, in some cases, wishes to avoid
offending, losing, or angering a partner. The DSM takes an exclusively individual
approach to sex, and assumes that if the sexual parts work, there is no problem;
and if the parts don't work, there is a problem. But many women do not define
their sexual difficulties this way. The DSM's reduction of "normal sexual function" to
physiology implies, incorrectly, that one can measure and treat genital and
physical difficulties without regard to the relationship in which sex occurs.

3) The levelling of differences among women. All women are not the same,
and their sexual needs, satisfactions, and problems do not fit neatly into
categories of desire, arousal, orgasm, or pain. Women differ in their values,
approaches to sexuality, social and cultural backgrounds, and current situations,
and these differences cannot be smoothed over into an identical notion of "dysfunction"--or
an identical, one-size-fits-all treatment.

Because there are no magic bullets for the socio-cultural, political,
psychological, social or relational bases of women's sexual problems,
pharmaceutical companies are supporting research and public relations
programs focused on fixing the body, especially the genitals. The infusion
of industry funding into sex research and the incessant media publicity
about "breakthrough" treatments have put
physical problems in the spotlight and isolated them from broader contexts.
Factors that are far more often sources of women's sexual complaints--relational
and cultural conflicts, for example, or sexual ignorance or fear--are downplayed
and dismissed. Lumped into the catchall category of "psychogenic causes," such
factors go unstudied and unaddressed. Women with these problems are being
excluded from clinical trials on new drugs, and yet, if current marketing
patterns with men are indicative, such drugs will be aggressively advertised
for all women's sexual dissatisfactions.

A corrective approach is desperately needed. We propose a new and more
useful classification of women's sexual problems, one that gives appropriate
priority to individual distress and inhibition arising within a broader
framework of cultural and relational factors. We challenge the cultural
assumptions embedded in the DSM and the reductionist research and marketing
program of the pharmaceutical industry. We call for research and services
driven not by commercial interests, but by women's own needs and sexual
realities.